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General NPI Number Information
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NPI Number | 1245864859
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Entity Type | Individual
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Provider Name | ALEXANDRA KAREN CARROLL DMD
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Gender | Female
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Dates
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Enumeration Date | 02/24/2020
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Last Update Date | 09/15/2022
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Provider Practice Location Address
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Address Line | 964 GLENWAY DR STE A
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City | STATESVILLE
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State | NC
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Zip | 28625-9204
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Country | US
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Telephone | 704-252-5793
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Fax |
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Provider Business Mailing Address
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Address Line | 22415 MARKET ST APT 1221
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City | CORNELIUS
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State | NC
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Zip | 28031-3034
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Country | US
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Telephone | 203-257-2931
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9562
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12112
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License Number State | NC
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